From my perspective, the most important and immediate issue remains access to quality health care for the underserved populations of America.  During my tenure as Director of the National Institute of Dental and Craniofacial Research (NIDCR), I was privileged to work on the Surgeon General's Report: Oral Health in America issued in May 2000.  This report documented the enormous health disparities that are found throughout the United States, especially with respect to oral health for young children and the elderly.  At that time a great deal of energy and enthusiasm was generated to finally address health disparities in the United States.  There was a federal surplus and states were keen to partner with the federal as well as private sectors to reduce disparities in their communities. Unfortunately, all of this changed with 9/11 and the years that have followed. 

For example, it is very sobering to me to review the National Health Center for Statistics' Trends in the Health of Americans (2006) and be reminded that socioeconomic status, using education and poverty levels as proxy measures, continues to be the greatest impediment to health. We readily discover that 80 percent of disease is found in 20 percent of the population.  During my seven-year tenure, I continue to be profoundly disturbed by the reluctance to mandate statewide or nationwide health care access, and the dysfunctional efforts to reward health literacy, health promotion and disease prevention. Why can we not be smarter about  providing access to comprehensive wellness-oriented health care in America and California?

Twelve-year-old Deamonte Driver of Maryland died last month from an abscessed tooth.  A dental infection migrated from the tooth through alveolar bone into the maxilla and entered the adjacent brain tissue resulting in a massive meningitis.  Unique oral bacteria were identified in brain tissue.  The Prince George's County boy's passing is an astonishing reminder that our country is far from a land of equal opportunity when it comes to health care.  Of course, it is not clear how many such similar deaths from tooth decay actually take place in America.  Since many very poor people access emergency room care only in dire conditions and at facilities that are overtaxed and underfunded, attention to the precise etiology of a devastating disease may not be ascertained.  Imagine, simple routine oral hygiene could have prevented this death.

According to the Children's Health Dental Project, 4.2 million children are born each year in the United States.  More than a quarter of them will have dental cavities by the time they are toddlers and more than half will have cavities by the time they reach second-grade.  Tooth decay remains America's most prevalent chronic childhood disease.  It is five times more common than asthma, and can be just as debilitating and fatal—as Deamonte's death has shown.  Why is this not recognized by parents, early childhood educators, all health professionals and health policy experts?

We know that not all children are at equal risk.  Children in poverty are twice as likely as their wealthier peers to develop cavities and, when they do, they develop twice as many.  In addition, children in poverty are more than twice as likely to suffer toothaches but less than half as likely to obtain dental care.  Why?  Because most dentists will not accept their government-sponsored insurance, and alternative treatment sites—such as health centers, hospitals and dental schools—are scarce and overburdened.  Some people blame the parents, but research shows that most poor parents strive to obtain proper care for their children.  In fact, in the rare instances in which states have fostered successful dental programs, the number of poor parents obtaining care for their children has increased dramatically—almost on a par with families that have private dental insurance.

We also know that for every dollar spent through Medicaid on children's health care, just five cents go toward dental care.  Comparing it proportionately, five times that amount is spent on the dental care of more affluent children.  This disparity is profoundly striking.  Ironically, many low-income children don't have access even to minimal dental care.  When Congress enacted the State Children's Health Insurance Program (SCHIP) 10 years ago to cover working-poor families, dental care was listed only as an option.  Oral health is not, and should never be, optional.  Deamonte's death (and that of tens of thousands of other children) has shown us that dental care is integral to a child's health and well-being.

Perhaps the greatest tragedy of Deamonte's death is that tooth decay is easily preventable, and ,when it does occur, can be treated at low cost.  Identifying the children most susceptible to dental problems and treating cavities as soon as they are detected is an investment we should be willing to make before another child's life is lost.  I would argue that we must be smarter and more precise with our funding.  We must elevate health literacy for all citizens in America.  Through health literacy, we can enhance health promotion, risk assessment and disease prevention.  In America children should never get tooth decay!

This month, legislators in Maryland and Virginia as well as Congress were moved by Deamonte's death.  They should take action to ensure that all children have access to care.  Congress should first require states to provide dental care through SCHIP, not only to children enrolled in the program but also to children whose family's private health coverage does not include dental care.  In America, 110 million people do not have dental insurance.  Congress has an opportunity to address this issue when they reauthorize SCHIP later this year.

Equally important is ensuring there are enough oral healthcare providers available to treat children across the country and that they are adequately compensated for their services.  Senators Jeff Bingaman (D-New Mexico) and Benjamin L. Cardin (D-Maryland) have proposed legislation titled the Children's Dental Health Improvement Act that expands school-based dental sealant programs, encourages dental schools to train more pediatric dentistry residents, improves Medicaid and SCHIP payment rates to dentists, and provides incentives to dentists willing to work in underserved parts of the country.  Please write your legislators in the House of Representatives and the Senate and encourage their support for this legislation.

America has never promised its children success, but it has always promised them opportunity.  Children who suffer from untreated tooth decay are often denied this opportunity because of dental pain that limits their ability to eat, sleep, learn or, as in the case of Deamonte Driver, enjoy life itself.  Moreover, we must also not forget the millions of Americans, age 65 years and older, who live in poverty and suffer from health disparities.  As civilized people we must ensure that all Americans have access to health care and education.

At the USC School of Dentistry we are dedicated to being part of the solution. For example, on March 21, 2007, the San Luis Obispo Tribune reported that the USC Mobile Clinic provided comprehensive oral health care to Ada Sanchez, age 10, in the parking lot of the Paso Robles Bauer-Speck Elementary School.  Ada was one of 98 children treated by Dr. Marjorie Domingo and her team of USC students, staff and faculty.  Marj was reminded that 10 percent of the children of San Luis Obispo County have not seen a dentist by the time they turn 20 years of age.  Along with feeding instructions and immunization schedules for all infants in California they also must have a "dental home" by their first year of life.  Health promotion is a key factor for their future growth, development and quality of life.  This is a call for action!

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